Adding to the other posts, this is my view.
First, there is a risk with any surgery and it's an irreversible process (you cannot undo a HR or THR), that's why we all got anxious before taking the step. But once the OA is bad enough, the "not surgery" option is gone, you've to do it. We all hoped (I did) that a new/miracle less invasive solution would come up not requiring a hip replacement (HR or THR), but we are still far from that.
Second, it's not straightforward, there are pros and cons to both HR and THR:
- THR is a well proven technique, it should last a long time in normal conditions, it's more immune to surgeon skill it seems and generally suitable to most patients, the chance of your body rejecting it (including metal reactions -unless is Metal on Metal-) is lower, and allows for good level of activity, but impact sports are NOT recommended. Revision (more likely for young patients) can be done, but there is less bone stock after the primary THR.
Of course, there are a few types of THR devices, with varying materials both in the acetabular cup and the femoral component, and that's an important consideration. It seems ceramic THR are among the favorite now.
So it's a safe, sound procedure, that works well for daily life and allows you to go back to an active life, but is not as suitable for very high level of activity (in particular impact sports).
- HR on paper resembles better the original hip joint, preserves more bone, theoretically it can last a long time (however the records only go as far as 15 years or so at this point) and a potential revision should be a reasonably straightforward primary THR.
It allows for a high level of activity (potentially), including impact sports (running, soccer, martial arts...).
However, it is a technically difficult procedure, with a steep learning curve for surgeons until they master it (and they must keep doing it over time). The results depend on surgeon skill and experience, correct device placement, device design, and patient selection (it seems gender and cup size are relevant factors, also the hip must be in relatively good condition for this to work; and patients with certain conditions like Avascular Necrosis, big osteophytes, severe dysplasia, low bone density etc might not always be ideal candidates).
Also, there is a risk of allergic reactions to metal, of two types: One, there is people allergic to metal, full stop (this is very rare and hard to find in pre-op tests); and two, metal debris (due to incorrect device placement, and bad device designs -like the infamous ASR model-) can cause serious problems and lead to a revision within 5 years or so.
The statistics show mixed or less than ideal results when compiling all HR records together, but once you filter out the bad devices (some already being retired from the market) and the surgeons not specialized in HR (i.e. those that do less than 50 or 100 a year and with less than hundreds of them overall), there is a subset of surgeons whose statistics are really good.
So for me it was:
- THR is "safe" but would limit my high expectations regarding sporting activities.
- HR is more "risky" (less margin for error), but would allow to live a very active life.
- The HR risks are minimized by choosing a specialized HR surgeon with vast experience and good track record (who would assess my suitability, select the right device and place it correctly). If things go wrong, I fall back to a THR.
I went for HR.
Regarding HR devices, BHR seems to be on top of the stats. However it's not the only good one. Also, the surgeon's experience with each device counts. My surgeon has been using BHR and Conserve Plus for years (he has done around 2000 of each), he used Conserve Plus for me (and I believe is his preferred now in most cases).
Of course, in the UK they will be a bit more biased towards BHR as it was invented there and naturally (I assume) most specialized HR surgeons are trained on it.
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